One of the most common complaints I hear about not receiving massage therapy is the pain associated after treatment. Over many years, I have spoken to numerous people who have had bad experiences with painful treatments and who will never again allow massage to be apart of their health and wellbeing. As a Relaxation Therapist, specializing in gentle touch massage, I, too, have a horror story to share about a massage experience I received a few years ago, which I will discuss later in this article.
There is a lot of controversy around pain associated with deep tissue massage compared to a less evasive relaxation massage. Some folks say, “if there’s no pain, there’s no gain,” a statement, I believe, is simply untrue. And while I do think different modalities do serve a purpose for various ailments, deep pain associated with massage is not one of them. There are a growing number of people who realize they do not need to endure muscle manipulation for relaxation to be effective.
When the body transitions into a deep state of relaxation through gentle massage, oxygen levels increase through deep rhythmic breathing, and the muscles and tendons become less tight and more relaxed, helping ease areas of discomfort within the body. Systematic stretching techniques, such as Progressive Muscle Relaxation, developed by Edmund Jacobson in the 1930s is based on the premise that mental calmness has a direct association with physical relaxation. It is also a vital component to achieving greater flexibility and mobility through a kinder, more gentle approach to painful muscle manipulation.
How Much Pressure Is Enough?
Massage therapy serves many modalities, all involving different types of treatments and varying degrees of pressure. Some people find specific types of massage, such as deep tissue, sports, or trigger point massages to be painful. And while some folks feel that digging deep into sore muscle areas will eventually alleviate the discomfort they are experiencing; one has to understand that not everything that hurts is therapeutic.
Everyone has different tolerances to pain; therefore, a massage that is painful for one person may not be painful for another. You must communicate directly to your therapist any discomfort you feel beyond your pain tolerance. Massages should never cause you physical pain, and you should not tolerate anything that goes beyond your pain threshold.
Types of Massages Relative to Pain
Deep Tissue Massage
A deep tissue massage is a type of massage that the therapist uses elbows and forearms to reach deep layers of muscle tissue and has said to be therapeutic in relieving chronic patterns of tension, helping with muscle injuries and sprains.
Many techniques fall under the category of deep tissue massage. Two examples of these techniques are; Trigger Point Therapy and Myofascial Therapy.
Trigger Point Therapy (Neuromuscular Therapy)
Trigger point therapy was developed in the 1940s by Dr. Janet Travell, President Kennedy’s former White House physician. Dr. Travell was accredited with her theory that pain experienced in one part of the body was associated with injury or dysfunction in another area of the body. Travell’s therapy called for an injection of saline (a salt solution) and procaine (an anesthetic known as Novocaine) into the knot or trigger point. It proved to be beneficial in the relief of pain, though some people found the injections themselves to be too painful to endure.
Myofascial Release Therapy
In the 1970s, Bonnie Prudden, a physical fitness and exercise therapist, discovered that applying sustained pressure to a trigger point location, without the need for injections, was just as effective to relieve pain. Prudden developed her techniques over several years and called the treatment myotherapy.
Today, the application of trigger point massage consists of applying deep pressure with the fingers, knuckles, elbows, and forearms to knead bumps on the muscles, commonly described as “knots.” Muscle knots are small, bump related areas on the muscle that can be felt and sometimes painful to the touch. Knots occur when the fascia (fibers of the bands of tissue) become tense and constricted and therefore tighten up. Trigger point or myofascial massage works by manipulating the muscle and releasing stored lactic acid, thereby encouraging blood and oxygen flow to the affected area. This modality of massage typically produces initial soreness, and to some, a tolerable pain associated with deep tissue manipulation.
Developed to help with muscle systems used for a particular sport, sports massage uses a variety of approaches to improve athletes in training, before, during, or after sports events. A sports massage is one of numerous types of massages explicitly designed to treat musculoskeletal injuries and pain and involves manual application of pressure to knead affected muscles and tendons.
Three standard techniques used in sports massage therapy are:
- The Effleurage Technique – The word “effleurage” is derived from the French verb “effleurer,” which means “to stroke,” or “to skim over.” This technique uses varied stroking applications with the hand gliding over the surface of the skin. Rhythmic form is done to increase circulation and stretch tight tissues.
- The Petrissage Technique – The word “petrissage” is derived from the French word “pétrir”, meaning to knead. This application involves kneading movements to the muscles by squeezing and releasing, stretching, and aligning the fibers to promote tissue fluids. The therapist uses the pads of the fingers, along with the thumbs, and applies firm pressure, then releases, designed to breakdown scar tissue and revive elasticity and blood flow.
- Tapotement Technique – The word “tapotement” originates from the French verb “tapoter”, meaning to tap or pat and is often associated with the word percussion. The therapist uses rhythmic movements by the hands, originating from a relaxed wrist, which strikes the body briskly and alternately, applying various depths of pressure to the area.
Rolfing is a form of deep tissue massage, named after Dr. Ida P. Rolf, an American biochemist in the early to mid 20th century. She referred to her body of work as “structural integration,” a focus on proper alignment of the body to maximize its potential for a healthier function. Dr. Rolf’s theory was based on how gravity affects the body and how it impacts proper alignment. Her claim was using deep pressure, and breathwork would relieve physical misalignment and improve flexibility and movement through a series of ten sessions, focusing on different areas of the body.
Rolfing can look a lot like traditional deep tissue, or even sports massage, though Rolfing involves working on deeper layers of the body, using stronger amounts of pressure to target these areas. Some people claim its benefits for posture problems, with studies showing effectiveness in the treatment of lordosis or curvature of the spine, while others, such as Christopher Barden, Psychologist, and attorney, claims Rolfing to be among “dangerous and controversial” methods of massage that pose a risk to the public.
Varying degrees of soreness has been reported as a possible side effect to this treatment, and therefore not recommended for those with a high sensitivity to pain. Should you be interested in receiving this type of treatment, it is essential to talk to your therapist about the pros and cons of this modality and ensure that you closely monitor your pain tolerance during your session.
Joseph Heller developed the Hellerwork technique in 1978. Shortly after becoming a Rolfing practitioner, he then trained and worked directly with Dr. Ida Rolf for six years, before becoming the first president of the Rolf Institute in 1976. Subsequently, Heller left the Institute to establish his brand of therapy, known as the Hellerwork technique.
The Hellerwork technique is a system of bodywork that combines deep tissue massage, body movement education, and verbal dialogue. It is designed to realign the body’s structure for overall health, improvement of posture, and reduction of physical and mental stress.
Similar to the Rolfing technique, Joseph Heller modeled the Hellerwork application around the same principals, focusing on releasing tension and stress in the fascia. The only difference between the two is the Hellerwork technique has been coined “The Gentler Form of Rolfing,” adapting the emotional and verbal element into the treatment.
How to Relieve Pain After A Massage
First and foremost, you must have an open dialogue with your therapist during your treatment. It is never okay, beneficial, nor healthy to endure pain above your tolerance level at any time, regardless of what modality you choose. If you experience pain over and above your level of comfort, immediately tell your therapist to stop! He or she will adjust the level of pressure more inline with your comfort and tolerance level.
If you experience pain after your treatment, there are certain things you can follow to lessen the discomfort:
Drinking water helps to replenish and repair damage caused to your muscles and tissues after a deep tissue massage. Water also helps to increase the circulation of both the blood flow and the lymphatic system, providing oxygen and nutrients to your muscles, organs, and other tissues.
Take a Warm Bath
Soaking in a warm bath can help ease aches and pains. It is recommended that you add Epsom salts (magnesium sulfate) to the water, which will be absorbed through the skin, while the warm water helps open blood vessels to increase circulation. If you are experiencing swelling, it is recommended that using a cold pack wrapped in cloth and applying it to the affected area works better than heat. Applying the cold should help to reduce any inflammation by numbing the area. You can alternate between heat and cold to treat the affected area – ten minutes each, alternating between applications should help to minimize pain.
It’s essential to listen to your body and not push through any discomfort or pain you may experience after a treatment. Understanding that your body has experienced an intense workout and your muscles have been stretched and manipulated is cause for you to do nothing other than rest. It is never advisable to book an activity that may require strenuous motions or physical alertness after a deep massage treatment. You should avoid such activities and pamper your body with physical and emotional rest after such treatment.
People Who Have Experienced Pain After Massage
“My Massage Therapist Broke Me”
“A few days ago, my friend was giving me a back rub and mentioned that my back and neck were really tight. I’ve been going through a stressful time lately, so I figured now was a good time to get a massage. I found a place on Yelp that had great testimonials/ratings, so I went there last night for a 60-minute massage. Big mistake.
So right off the bat, the guy was focusing only on my neck and back. He said there were really bad knots. It hurt like CRAZY… I had to keep telling him to go lighter and he kept saying that he WAS going as light as possible, but he had to get the knots out. It hurt like….oh my god. I can’t believe how much it hurt. Finally, I had to tell him to stop. I was so upset.
When I got home, I felt really achy. I took a hot shower, put icy hot on my neck, and went to bed. I woke up in the middle of the night really hurting, so I got a hot water bottle on my back and was able to sleep a little. When I woke up for work this morning, I was in AGONY. I took two Advil and slathered more Icy Hot all over me, but holy crap. This hurt so much. I don’t know what to do.”
“Massage or Massacre? Spa Injuries Exposed”
“For Rogers, the massage didn’t soothe her muscles, it left her with severe muscle injury from her neck to her pelvis.
Part of the problem could have had to do with a communication barrier. Indeed, the American Massage Therapy Association (AMTA) recommends that consumers “communicate clearly” with their masseuse.
The AMTA also encourages consumers to “report any discomfort [and] give feedback about [the] amount of pressure.”
But this may not be as easy as it sounds, Rogers said. “She seemed very confused,” she recalls. “I told [the masseuse] I wanted a Swedish massage, but she still seemed confused … when she popped my neck, I said ‘Don’t do that!’ She just nodded … like everyone says that.”
As the assault continued, Rogers describes the masseuse as “pressing my leg down … trying to get it to crack, but I’m not flexible like that. I had to stop her.”
And when the masseuse asked Rogers if she was okay, she felt the masseuse’s concern was “more like an uncomfortable [being naked] ‘Okay,’ not [asking] if I was hurting ‘Okay’.”
Even her back massage was unconventional. According to Rogers, “I heard her hop up on the table [with me].” Rogers said the masseuse then pulled her arm backwards, “like you would put handcuffs on” — and that’s when her pain really began.
“She put her knuckles [in my back] … She was pressing me,” she said. “I felt smushed between the pressure [of her knuckles] and the table … My ribs were pressed.”
Telling the masseuse that she was in pain should have stopped her torture, but Rogers finally realized, “I don’t know if she understands English that well.”
Once her tormenting massage was over, Rogers says she “felt sore in my ribs and back a little … I thought maybe I was just tense.” She tried to “fight it” for a few days, but the pain became unbearable.
“I leaned over in my chair to pick up a pen off the floor and I started crying,” she said. “It hurt to breathe.” Looking for answers, Rogers went to New York University Medical Center TISCH Emergency Department.
Upon hearing her story and observing her crippling pain, Dr. Dainius Drukteinis became worried about possible broken ribs, a blood clot in her lungs, or even damage to her spleen from the pressure applied during the massage.
Drukteinis, who said he has “definitely seen patients with muscle strains from massage,” felt the seriousness of Rogers’s symptoms called for “more complex scans … because she was in a lot of pain.”
Fortunately, Rogers’s tests were normal. The doctor diagnosed her with severe muscle strain and treated her with heavy pain medications and strict instructions to rest.”
“I’m physically active, and once or twice a year, my neck and shoulder “seize up” with thick knots, the focus being an intense knot under one of my scapulae. I went for a deep tissue massage thinking it would break up the tension. While he really went to town on that shoulder, I was okay with the level of pressure because I thought it was going to help.
When I sat up to get dressed, I knew immediately something was terribly wrong: there was an excruciating throbbing electrical type sensation radiating down my arm. I could barely drive home. I thought maybe it would go away after 24 hrs or so and took some pain reliever. It only got worse -the level of pain over the next few days went to a 10- and I went to urgent care and the ER to try to find relief. Pain meds only took it from a 10 to a 9. The only relief I could find was positional -if I held my arm up over my head, the pain went from a 9-10 to a 6-7. None of the medical professionals gave any insight as to when I could expect to see some improvement.
I was very very frightened that I had permanently messed up my life. Long story short- I did heal completely but it took a long time. Physical therapy helped as did relaxation with heat and some light cardio to improve circulation.
The initial two weeks were hell; couldn’t drive, cancelled plans, etc. About week 3-4 I felt perhaps I was healing and was able to do short driving trips. It was about week 8 where I felt more or less healed, though I still had some light tingling in my hand and fingers. That eventually subsided. All of this because of a deep tissue massage that was supposed to help. Never again.”
Posted on Disabilityhappens.com by Anita
My Personal Story
As promised at the start of this article, I would share my personal story of a massage treatment I received a few years back. As a Relaxation Therapist who has practiced gentle massage for over 50 years, I have helped numerous people heal through the art of relaxation. I can claim that never once have I induced pain, nor caused harm to a single one of my clients. I advocate for gentle massage as part of a healthy and balanced lifestyle, because in my opinion, pain plus pain, equals pain, and painful treatments are not always therapeutic.
With that said, I am always asked: “Do you have regular massage treatments, yourself?” And, the answer is; Yes, I do! Massage is part of my lifestyle regime; I don’t consider it a luxury only afforded when I feel aches or pains. It, to me, is a discipline I require so that I may continue to help others. Personally, I do not ask for, nor receive deep tissue massage, and I am very explicit with my therapist before treatment commences. Sessions I receive include light to medium pressure massages, treatments that align with my pain tolerance and support the therapeutic nature of the procedure.
A few years ago, I scheduled a massage session with a new therapist. Unfortunately, my long-time and most trusted therapist relocated to another province in support of her husband’s new career and launch her new practice. Before our initial visit, I had an opportunity to meet with my new therapist to discuss who I am, what I do, and the specific treatment I require. I felt very comfortable knowing she understood my methodology relating to gentle massage and the techniques involved in achieving beneficial results, for me.
As we begin our hour-long session, I was impressed, not only with her technique but with her attention to detail. She worked on critical areas of concern such as my hands, wrists, and forearms, in need of a bit more attention. Towards the end of my session, she used a technique known as a Sub-Occipital Release. This treatment is used to stretch and soften the sub-occipital muscles (a cluster of muscles between your skull and the top vertebrae). RMT’s commonly use this technique using both hands, while the client’s head and neck rest upon his/her fingertips. After a couple of minutes of this procedure, I began to feel a dull ache, specifically at the base of my skull, where her fingertips were depressed. I mentioned my discomfort, though she assured me that it was normal to feel a slight burning sensation as the muscles lengthen and become more pliable. I remember her saying the benefit will outweigh the discomfort. It was at that very moment I consented and continued with the treatment which broke my number one cardinal rule – NEVER allow anyone to push past your pain threshold!
After I arrived home, I took a warm shower (not hot), hoping to relieve the burning sensation from the base of my skull down the length of my neck. A few hours had passed, and the pain was not subsiding, in fact, it became excruciating – so much so, I couldn’t move my head, nor my neck without unbearable agony!
That evening, I ended up in the emergency room at the hospital with an injection of morphine to combat the pain. I prayed this medication would take effect immediately, but unfortunately, it didn’t. As I waited for the results from the X-rays and was monitored for possible side-effects of the medication, I became angry at myself for not listening to my gut feeling, not following my number one golden rule!
I’m happy to report there was no permanent damage, and the Dr. diagnosed it to be a pinched and inflamed nerve. I continued to take the medication for two days following the incident. It took about five days before I was pain-free. Needless to say, I learned my lesson! I will never, ever allow anyone to push past my pain threshold, and will never, ever receive a Sub-Occipital Release again.